Link Between High Unexpressed Anger In MS Patients And Nervous System Damage

People with Multiple Sclerosis (MS) feel more than twice as much withheld anger as the general population and this could have an adverse effect on their relationships and health, according to a study published in the December issue of the European Journal of Neurology.



Italian researchers assessed 195 patients with MS, using a range of scales that measure anger, depression and anxiety, and then compared them with the general population.



They were surprised by the results, which showed that while patients experienced almost twice the normal level of withheld anger and exerted low levels of control on their anger, their expressed anger levels were similar to the general population.



This, together with the fact that the elevated withheld anger levels were not related to the severity of the patients' MS, suggests that these inconsistent changes were caused by nervous system damage, rather than an emotional reaction to the stress of the disease.



"We believe that the higher levels of withheld anger shown by the study subjects is due to demyelination, loss of the substance in the white matter that insulates the nerve endings and helps people receive and interpret messages from the brain" explains lead researcher Dr Ugo Nocentini from the IRCCS S Lucia Foundation in Rome.



"The way we process anger is controlled by complex interconnections between the subcortical and cortical systems, notably the amygdale and basal ganglia and the medial prefrontal cortex. We believe that the demyelination process that causes the root symptoms of MS also disrupts the pathways that control how we deal with withheld anger."



The patients who took part in the study comprised 150 with relapsing-remitting MS and 45 with progressive MS. More than two-thirds (68 per cent) were women, the average age of the participants was 40 and the average time since diagnosis was 11 years.



Researchers evaluated the participants using the State Trait Anger Expression Inventory, the Chicago Multiscale Depression Inventory and the State Trait Anxiety Inventory.



The researchers then looked at age and sex-matched subjects in the general population and identified the levels of anger experienced by the 25 per cent of people with the highest scores.



They found that MS patients:
Were more than twice as likely to experience high levels of withheld anger, with 60 per cent of patients recording the same high levels as the top 25 per cent of the general population.


Exerted a low level of control on their anger, with just 11 per cent of patients reporting the same high levels of control compared to the top 25 per cent of the general population.


Were about the same as non MS patients when it came to expressed anger, with 30 per cent of patients reporting the same high levels as the top 25 per cent of the general population.

During the study the authors also compared the anger scores against selected demographic and clinical characteristics and found they were independent of age, education, disease duration and course, disability and fatigue severity. The only notable difference was that women reported higher levels of current anxiety.



"Our findings clearly show that anger characteristics in MS patients differ from those observed in the general population and the overall results surprised the research team" concludes Dr Nocentini.



"For example, patients reported low levels of anger control and high levels of withheld anger, yet the scores for expressed anger were similar to those of the general population.



"We would have expected greater consistency between withheld and expressed anger and higher levels of expressed anger as a consequence of low anger control."



The authors conclude that damage to the fibres in the areas of the brain where anger issues are processed is the most logical explanation. They also say the findings have important implications for clinical practice.



"Anger disrupts interpersonal relationships and this is particularly true for withheld anger, which might go unrecognised by other people" says Dr Nocentini. "Witheld anger has been reported to be associated with physical problems, in particular high blood pressure and vascular disorders, and may have a negative effect on the general health of MS patients.



"Because withheld anger has no, or few, overt manifestations, and is unlikely to be recognised by clinicians or reported by patients, it is important that MS patients are asked if they experience abnormal anger."

Could A Diagnostic Blood Test Be Created For Depression?

Psychiatry, unlike many other areas of medicine, lacks diagnostic blood tests. Blood tests have been extremely useful in helping doctors make medical diagnoses and aiding them in treatment options for conditions and diseases in most medical fields.


An article in Biological Psychiatry reports that Dutch researchers may eventually generate blood tests for psychiatric conditions, such as depression.


Under increasingly intensive research by scientists are the studies of:

Variations in DNA (genes) that can be extracted from blood cells
Genomics like proteomics, the measurement of the levels of specific proteins in the blood
Gene expression profiling, which measure the levels of RNA produced from DNA as an indication of the activity of specific genes.

Dutch researchers evaluated blood gene expression profiles in two groups of people:

Patients diagnosed with major depressive disorder (MDD)
Healthy individuals

They identified a set of 7 genes in whole blood that could tell the un-medicated MDD patients from the healthy ones.


Dr. Sabine Spijker, one of the authors, said:



This is a first, but major step in providing a molecular diagnostic tool for depression.



Experts say this type of diagnostic test would be especially useful for diagnosing mental health disorders when it is more difficult to have a conversation with the patient; it would also be unbiased.


The writers add that blood tests of this type may also help in reducing the stigma associated with mental health illness, conditions, and problems.


Dr. John Krystal, Editor of Biological Psychiatry cautions:



It is far too early to be confident that gene expression profiling will lead us to diagnostic or prognostic tests for depression. However, the objective of this line of research is extremely important. In the past, many types of tests have been explored as potential diagnostic markers, but they all have failed to have sufficient sensitivity and specificity to guide doctors in making psychiatric diagnoses or choosing between treatments. I look forward to seeing whether the patterns of gene expression profiling are replicable and diagnostically specific as multiple groups report their findings.


Hopefully, say the authors, this study may be a stepping stone towards finding markers that may predict treatment outcome and recurrence.


"Stimulated Gene Expression Profiles as a Blood Marker of Major Depressive Disorder"

Sabine Spijker, Jeroen S. Van Zanten, Simone De Jong, Brenda W.J.H. Penninx, Richard van Dyck, Frans G. Zitman, Jan H. Smit, Bauke Ylstra, August B. Smit, Witte J.G. Hoogendijk

Biological Psychiatry, Volume 68, Issue 2, 15 July 2010, Pages 179-186

In Patients With Depression It Takes Only 5 Minutes To Assess Disability

A research team has tested the utility of the short version of WHO-DAS II, a tool to assess within five minutes, disability in patients with depression, "which in the case of primary care is even more practicable than the long version of the instrument." In Spain, more than 10% of the population suffer from severe depression.



The family doctor is usually the first to screen an individual who feels depressed. For this reason, training and tools that enable the diagnosis of this illness and the disability associated with it are essential. A new study now certifies the reliability and validity of the 12-item WHO-DAS II, the short version of the World Health Organization scale to assess disability in primary care patients.



Juan Vicente Luciano's research team, at Parque Sanitario Sant Joan de D?©u, in Sant Boi de Llobregat (Barcelona), observed that the psychometric information available in Spain on WHO-DAS II in patients with depression was insufficient: "a significant limitation given the high prevalence of this pathology among patients who consult their family doctor", he explains to SINC.



The study, published in the Journal of Affective Disorders, has been based on 3,638 primary care patients from 17 Spanish provinces who have suffered "a major first depressive episode ", according to their family doctor.



"Luciano indicates that "the score obtained by patients on the new scale is more capable at predicting the severity of their depression symptoms than the scores obtained in a quality of life instrument used in the same study".



The authors conclude that the short version of this tool is "as reliable and valid as the full version" in assessing disability in patients with depression, and is even "more suitable" than the long version in the primary care field, given the short time (less than five minutes) it takes to use it.



WHO-DAS II is a tool that assesses functioning and disability in six areas (understanding and communication; ability to get by in their environment; self-care; relationships with others; daily life activities and participation in society). Its psychometric properties have been tested in more than 14 countries and in 16 different languages.



Spain: a depressed country?



Scientific literature shows a high prevalence of mental disorders in Spain. According to a study published in the journal Medicina Cl?­nica in 2006, 19.5% of the population has had a mental disorder at some stage in their life. The most frequent mental disorder is a severe depressive episode, which affects 10.5% of the population.



In 2008, further research on the frequency of depression among primary care patients in six European countries, published in the British Journal of Psychiatry, revealed that Spain has the highest rate of depression in Europe, particularly among women.



The latest data from the World Health Organization (WHO) show that depression affects 121 million people around the world and is the main cause of work-related disability. Although this pathology can be diagnosed and treated effectively in primary care, less than 25% of people affected receive the appropriate treatment.



References:
Juan V. Luciano, Jos?© L. Ayuso-Mateos, Ana Fern??ndez, Antoni Serrano-Blanco, Miquel Roca, Josep M. Haro. "Psychometric properties of the twelve item World Health Organization Disability Assessment Schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode". Journal of Affective Disorders 121:52-58, febrero de 2010.


King et al.: "Prevalence of common mental disorders in general practice attendees across Europe". British Journal of Psychiatry (2008);192:362-367.


Josep M. Haro, Concepci?? Palac?­n, Gemma Vilagut, Montse Mart?­nez, Mariola Bernal, Inma Luque, Miquel Codony, Montse Dolz, Jordi Alonso y el Grupo ESEMeD-Espa?±a. "Prevalencia de los trastornos mentales y factores asociados: resultados del estudio ESEMeD-Espa?±a". Medicina Cl?­nica (2006);126(12):445-51.

For Trials Documenting CVD Burden Chicago Scientist Honored

The American Heart Association awarded its Population Research Prize to Paul K. Whelton, M.D., of Loyola University in Chicago, for pioneering population trials that are the informational basis for much of today's fight against cardiovascular diseases.



"For more than two decades, Dr. Whelton has directed highly significant longitudinal, cross-sectional and interventional studies that are providing medical science vital data on the burden of disease facing populations in the United States, Southeast Asia, North Africa and South America," said Daniel Jones, M.D., president of the American Heart Association.



Jones presented the annual $5,000 award for outstanding population research during the American Heart Association's Scientific Sessions 2007 at the Orange County Convention Center.



Jones said data compiled by Whelton "have brought into sharp focus the extent of the problem that heart and blood vessel diseases pose, and have sketched a useful blueprint for preventive actions that can be taken to reduce risk and eventually conquer these diseases."



Whelton's contributions include the first worldwide estimates of the prevalence of hypertension.



Beginning in the 1980s, Whelton's research "generated compelling evidence" that high blood pressure and diabetes are risk factors for renal disease, Jones said.



Whelton has also led in identifying non-pharmacologic approaches for preventing and treating high blood pressure. He chaired the two largest lifestyle intervention trials for hypertension prevention.



After medical training in his native Ireland, Whelton served on the faculty of the Johns Hopkins School of Medicine and School of Public Health in Baltimore. He was also dean of the Tulane School of Public Health and Tropical Medicine in New Orleans before becoming president and chief executive officer of the Loyola University Health System in Chicago.

Depression Rife Among Medical Students

Medical students frequently suffer from depression, especially during their internship years. New research published in the open access journal BMC Medical Education reveals the extent of the problem and features a detailed analysis of the symptoms and sufferers.



Sergio Baldassin, from the ABC Regional Medical School, Brazil, led a team of researchers who carried out a study on 481 medical students in the private medical school near the S??o Paulo state capital. He said, "We used cluster analyses to better describe the characteristics of depressive symptoms - affective, cognitive, and somatic. This is the first study to directly evaluate, in a cross-sectional design, the characteristics of depressive symptoms by applying such clusters".



Affective symptoms represent the core symptoms of a depressive mood, based on students' reported levels of sadness, dissatisfaction, episodes of crying, irritability and social withdrawal. The cognitive cluster assessed pessimism, sense of failure or guilt, expectation of punishment, dislike of self, suicidal ideation, indecisiveness and change in body image. Finally, the somatic cluster assessed the presence of slowness, insomnia, fatigue, loss of weight and loss of sexual interest. Baldassin said, "There was a high prevalence towards depressive symptoms among medical students, particularly females, mainly involving the somatic and affective clusters. Of the students in our study, 38% had at least 10 of a possible 63 symptoms of depression".



The authors' cluster analysis found that the reasons for most students' depression scores were in the affective cluster, and that the problem was at its worst in the internship years. Cognitive cluster symptoms were also highest in this year, probably due to feelings of fear and insecurity about entry into the hospital environment. According to Baldassin, "Frequently pre-internship students fear they 'know nothing', and are insecure about the physical examination of other people". Likewise, somatic cluster scores were highest during internship, reflecting sleepless nights on call, devoid of friend and family support.



Having a parent who is a doctor was found to reduce the depression risk.



The authors conclude, "The increased depression scores during the internship period of medical school are associated with a decrease in student health, and this is probably the period when professors and educators should try to be most aware of suicidal thoughts and risk in their students".







Notes:



1. The Characteristics of Depressive Symptoms in Medical Students during Medical Education and Training: A Cross-sectional Study

Sergio Baldassin, T??nia CTF Alves, Arthur G Andrade and Luiz A Nogueira-Martins

BMC Medical Education (in press)


Article available at journal website: biomedcentral/bmcmededuc/


All articles are available free of charge, according to BioMed Central's open access policy.



2. BMC Medical Education is an open access journal publishing original peer-reviewed research articles in undergraduate, postgraduate, and continuing medical education. BMC Medical Education (ISSN 1472-6920) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.



3. BioMed Central (biomedcentral/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

Routine Screening For Postnatal Depression Not Cost Effective, UK

Routine screening for postnatal depression in primary care - as recommended in recent guidance from the National Institute for Health and Clinical Excellence (NICE) - do not appear to represent value for money for the NHS, concludes a study published on bmj.



The results suggest that both the NICE guidance and widespread current practice should be reviewed.



More than one in 10 women suffer from postnatal depression six weeks after giving birth, yet fewer than half of cases are detected in routine clinical practice. Formal identification methods, such as postnatal or general depression questionnaires, have been advocated but have attracted substantial controversy.



Furthermore, guidelines issued by NICE in 2007 recommend the use of specific questions to identify possible postnatal depression, but the cost effectiveness of this strategy is uncertain.



So researchers at the University of York used a computer model to evaluate the cost effectiveness of formal methods to identify postnatal depression in primary care.



Routine use of either postnatal or general depression questionnaires did not appear to be cost effective compared with routine care only, largely due to the cost of managing those wrongly diagnosed as depressed, say the authors.



For example, the Edinburgh postnatal depression scale had an incremental cost effectiveness ratio of ??41,103 per quality adjusted life year or QALY (a combined measure of quantity and quality of life) compared with routine care only.



The ratio for all other strategies ranged from ??49,928 to ??272,463 per QALY compared with routine care only, well above the conventional NHS cost effectiveness threshold of ??20-30,000 per QALY.



In contrast, the strategy of administering only routine care was most likely to be cost effective.



These findings suggest that both the recent NICE guidance and widespread current practice do not result in value for money for the NHS, and do not satisfy the National Screening Committee's criteria for the adoption of a screening strategy as part of national health policy, conclude the authors



They call for further research to quantify the cost of incorrect diagnosis and the wider impact of postnatal depression treatment strategies on the quality of life of the mother and her family.



Link to paper

Source
British Medical Journal

States With Higher Uninsured Rates Have Higher Suicide Rates, According To Report

States with higher rates of residents who lack health insurance have higher rates of depression and suicide, according to an unpublished study commissioned by Mental Health America and released to USA Today. For the study, sponsored by Wyeth Pharmaceuticals, Tami Mark of Thomson Healthcare used federal data on mental health and state databases to develop a "depression index" and ranked states based on rates and seriousness of depression, and rates of suicide.

Maryland, New Jersey, Illinois and Hawaii had the lowest rates of depression and suicide, and Utah, West Virginia, Idaho and Nevada had the highest rates, the study found. According to the study, rates of suicide in states with the highest rates exceeded those in states with the lowest rates by two to four times. States with lower rates of suicide had higher rates of adults who received mental health care, more availability of psychologists and psychiatrists, and mental health parity laws that require health insurers to provide equal levels of coverage for physical and mental illnesses, the study found.

Mark said that, although the study does not link a lack of access to mental health care to higher rates of depression and suicide, "it suggests we should be monitoring mental health care and comparing outcomes." David Shearn of Mental Health America said that the study highlights the importance of health care in the 2008 presidential campaign, as well as mental health parity legislation under consideration in Congress. "There are consequences of no mental health treatment: it can cost lives," he said.

John Holahan, director of the Health Policy Center at the Urban Institute, said that the study is "pretty interesting and important because it suggests that having insurance and improving access to care has an impact on mental health and suicide" (Elias, USA Today, 11/28).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Classification Methods For Identifying The Neural Characterics Of Antidepressant Treatment

Depression is a major public health problem, and one of the most important challenges for psychiatrists is to determine whether an individual with depression should receive cognitive-behavioral therapy or treatment with antidepressant medication. A study by researchers from Emory University, presented at the Annual Meeting of the Organization for Human Brain Mapping in San Francisco, used brain imaging along with sophisticated statistical techniques to examine the differences in brain function that result from these two different kinds of treatment. Forty individuals with depression were scanned with magnetic resonance imaging after undergoing cognitive behavioral therapy or antidepressant therapy. The researchers found that they could distinguish the brain activity of individuals undergoing the two different treatments, and in particular that the two treatments differently affected the communication of the brain areas that are thought to play a role in depression, including the communication between the prefrontal cortex and the nucleus accumbens, and between the subgenual cingulate and the thalamus. The results provide a basis for future research that will try to predict which individuals will benefit from different treatments for depression.


Authors: S. Chen, G. Derado, Y. Guo, F.D. Bowman, Emory University, Atlanta, GA, United States

Second-generation antidepressants are very similar but have different side effects

Because clinical depression is so disabling and affects more than 16 percent of adults in the United States at some time in their lives, researchers have worked hard to develop more effective treatments. But how much better are the newer pharmaceuticals?


Many second-generation antidepressants, despite differences in drug classification and cost, offer patients essentially the same benefits with little variation in risks, University of North Carolina at Chapel Hill researchers have found.


Such antidepressants include selective serotonin reuptake inhibitors (SSRIs) and other drugs that affect the activity of neurotransmitters in a selective way.


In a paper published online today (Sept. 19) and to be published in the October issue of the journal Annals of Internal Medicine, Dr. Richard A. Hansen and colleagues examined the effects of 10 commonly prescribed second-generation antidepressants. Those drugs included familiar brand-name drugs such as Prozac, Zoloft, Effexor, Wellbutrin and Paxil.


Hansen is assistant professor of pharmacy at the UNC School of Pharmacy. The study he led involved investigating the medications' role in the initial treatment of adults suffering from major depression by combining and systematically analyzing data from 46 randomized, controlled trials.


Other authors, all at UNC, are Drs. Gerald Gartlehner and Timothy S. Carey of the Cecil G. Sheps Center for Health Services Research, Dr. Kathleen N. Lohr of the health policy and administration department at the School of Public Health, and Bradley N. Gaynes of the School of Medicine's psychiatry department. Carey, professor of medicine, directs the Sheps Center. Gartlehner is associate director of the RTI-UNC Evidence-based Practice Center.


"Past studies have compared the effectiveness of second-generation antidepressants with that of placebo or older treatments but have not systematically evaluated how the second-generation agents compared to each other," Hansen said. "Given the number of second-generation treatments available, cost differences, widespread use and the general lack of consensus in how the drugs compare, our research can help patients, clinicians and policy makers decide which drug is best."


The bottom line was that one was about as good as another in terms of effectiveness, but the likelihood that patients experienced certain side effects differed between compounds, he said.


"Comparative evidence on these drugs suggests that there are only minimal differences in efficacy, although some of the drugs come with an increased risk of certain side effects," Hansen said. "Understanding the likelihood of the side effects and matching this information with patients' lifestyle and preferences for anticipated side effects may help improve drug treatment of depression.


"Although our study did not specifically assess the impact of drug costs or differences in dosing regimens on how patients fared, those factors also may be important determinants in drug selection," the scientist said. "That's in the absence of patient preference or a clear choice for which agent is best for a given person."


Limitations of the study were that published data from some trials was not as complete and comparable as researchers would have preferred, Hansen said. Most data was from trials sponsored by drug companies, and questions remain as to how unbiased such studies are.


Support for the investigation came to the Cecil G. Sheps Center for Health Services Research from the Drug Effectiveness Review Project, a collaborative program coordinated by the Center for Evidence-Based Policy at the Oregon Health and Science University.


In 2000, the economic burden of depression was estimated to be $83.1 billion, Hansen said. Although drug treatment does not work for all patients, drugs are usually considered the first and potentially best treatment in part since primary care physicians prescribe the majority of antidepressants in this country.


David Williamson

rdtokidsemail.unc

919-962-8596
University of North Carolina at Chapel Hill

unc


View drug information on Effexor; Paxil CR; Prozac Weekly.

Depression In Moms With Breast Cancer May Exacerbate Related Anxieties In Their Children

A woman's breast cancer diagnosis can wreak as much havoc on her emotions as it does on her physical health. Mothers who experience bouts of depression during their battles with breast cancer may find that the effects reach beyond their own psyches to those of their children. According to data analyzed by University of Pittsburgh researchers and reported this weekend at the American Psychosocial Oncology Society's Fourth Annual Conference in Austin, Texas, children of depressed breast cancer patients were more likely to be concerned or anxious about their mother's cancer and its implication for their families.



While children's emotional responses to their own illnesses are well-documented, this study, "The Effect of Depressed Mood in Mothers with Breast Cancer on Their Children's Illness-Related Concerns," is the first to examine the relationship between children's concerns and a mother's cancer-related depression.



"This data should prompt new considerations among oncology clinicians," said Beth R. Grabiak, M.S.N., C.R.N.P., a doctoral candidate in the health and community systems department at the University of Pittsburgh School of Nursing who led the data analysis. "We need to think about the impact depression has on the breast cancer patient's entire family as she undergoes treatment for her cancer."



The results were obtained through a secondary analysis of data from a randomized clinical trial that was funded by the National Institutes of Health and led by University of Washington researchers. That primary study, called "Enhancing Connections," collected information from a cross-section of 155 mothers with stage 1, 2 or 3 breast cancer and 155 of their children aged 8 to 12 years from six states. When more than one child was in the home, each mother selected one child to be followed by the study.



Mothers' depression was measured by the Center for Epidemiological Studies Depression Scale (CES-D), while children's concerns about the illness were determined by their responses to a 93-item questionnaire. In addition to quantifying total illness-related worries, the questionnaire responses also shed light on three subcategories: treatment-related concerns, existential concerns and family-related concerns.



When adjusting for other variables like children's age and gender, depression in mothers with breast cancer significantly predicted children having higher overall concerns about the illness. Furthermore, depression significantly predicted increased family-related worries in the children.



"It would be expected for children to worry about their mothers in the face of a difficult illness. It's somewhat surprising, however, that children's anxieties extended to concerns about the entire family," Ms. Grabiak said.



"This study's results have important implications for the mental well-being of families affected by breast cancer. Well-intentioned parents may hesitate to talk openly about the disease's emotional impact in an effort to protect their children, who in turn may attempt to hide their concerns and suffer in silence. Yet, the child's anxieties never disappear. They often are manifested in other ways, such as withdrawn behavior," Ms. Grabiak said.



Most estimates suggest that nearly one quarter of women diagnosed with breast cancer have young children, meaning that as many as 100,000 children will be impacted by the diagnosis this year alone. Ms. Grabiak suggests that, while not every breast cancer patient will become depressed, health care providers who are involved in cancer treatment should look for signs of depression in their patients, too.



"The oncology team's responsibility goes beyond treating the cancer alone," she said. "Spotting depression early and referring a mother to treatment has clear benefits for her entire family."



While this study's results are noteworthy, the subject has great potential for further exploration. Because this data was culled through a secondary study, a primary study on the topic should be conducted to further validate the results. Additionally, an examination of longitudinal data, as opposed to the cross-section examined in this work, would shed more light on the relationship of children's illness-related concerns and their mother's depression.






CONTACT: Clare Collins


The research was funded by the National Cancer Institute. Additional researchers on the project were Susan M. Sereika, also of the University of Pittsburgh, and Frances Marcus Lewis, of the University of Washington School of Nursing.



Kelli McElhinny


University of Pittsburgh Schools of the Health Sciences

Hurricane Katrina Saw Fall In Suicide Rate But Rise In Serious Mental Illness Rate

The rate of serious mental illness doubled as a result of the Katrina hurricane, say researchers from the Hurricane Katrina Community Advisory Group Survey, led by Harvard Medical School. However, fewer people felt compelled to commit suicide, because people bonded during and after the disaster. The National Institute of Mental Health funded the study. The Katrina Hurricane killed approximately 1,600 people and severely disrupted the lives of 2 million families.


The survey found that:


-- Of 1,043 survivors surveyed, 11.3% were diagnosed with a serious mental illness long after the hurricane. This compares to 6.1% before the hurricane. 19.9% had mild-moderate mental illness, compared to 9.7% before the hurricane.


-- There are probably around 200,000 people facing serious mental illnesses, such as PTSS (Post Traumatic Stress Syndrome) and depression, in Alabama, Louisiana and Mississippi.


-- 50% of Mississippi survivors experience nightmares


-- 85% of survivors experienced devastating financial losses


-- Over 30% of survivors suffered physically in a serious way



When referring to a drop in the suicide rate, B. Kessler, Harvard Medical School, said "We found an extraordinarily high proportion of our sample who said that despite the understandable sadness with all they lost and the understandable anxieties about the future - that they felt closer to their loved ones, they felt connected to the community in a way they didn't before. They felt much more religious, they felt that they had a purpose in their life and a meaning."


The 1,043 Katrina Hurricane survivors were compared to a similar sized group in the same area in 2001-2003. The current Katrina survivors will be monitored over the next seven years.


The researchers also found that 6% of high-income people remained at home during the storm, compared to 40% of low-income people.


Hurricane Katrina was the deadliest hurricane in the US for seventy years. It was also the most expensive natural disaster in the country's history. Over half-a-million people were evacuated. Almost 90,000 square miles were declared a disaster area - equivalent in size to the whole of the UK. There are still 100 people missing.


Mental illness and suicidality after hurricane Katrina

Ronald C. Kessler, Sandro Galea, Russell T. Jones, & Holly A. Parker on behalf of the Hurricane Katrina Community Advisory Group

WHO Bulletin - doi:10.2471/BLT.06.033019

Click Here To Download PDF File of Report

Cigarette Smoking 'Could Increase Risk Of Depression'

New research published in the British Journal of Psychiatry suggests smoking could increase the risk of depression.



The study, carried out by researchers from the University of Otago in New Zealand, followed over 1,000 people. At the ages of 18, 21 and 25, the participants were asked about their smoking habits and whether they had symptoms of depression.



The researchers found a strong association between smoking and depression. People who were dependent on nicotine were more than twice as likely to have symptoms of depression as those who were not nicotine dependent.



The researchers looked at this relationship in more detail using a sophisticated statistical technique called structural equation modelling (SEM). This analysis showed that smoking increases the risk of developing depressive symptoms, rather than people being more likely to smoke because they're depressed.



Commenting on the results, lead researcher Professor David Fergusson said: "Our findings are consistent with the conclusion that there is a cause and effect relationship between smoking and depression, in which cigarette smoking increases the risk of developing symptoms of depression.



"The reasons for this relationship are not clear. However, it's possible that nicotine causes changes to neurotransmitter activity in the brain, leading to an increased risk of depression."



Professor Fergusson and colleagues do emphasise that their study does not prove that smoking causes depression, and said that the study "should be viewed as suggestive rather than definitive".



References

"Cigarette smoking and depression: tests of causal linkages using a longitudinal birth cohort"

Boden JM, Fergusson DM and Horwood LJ (2010)

British Journal of Psychiatry, 196:440-446

Risk Factors For Depression Similar For Men And Women, Virginia Commonwealth University Study

Men and women may share more similarities than previously thought when it comes to the risk factors for major depression, according to a new study by Virginia Commonwealth University researchers.


In the January issue of the American Journal of Psychiatry, researchers reported that although there is a wide range of risk factors for depression that can act at different stages of development, the patterns of causes of depression for men and women are fairly similar. Some of these risk factors include childhood sexual abuse, poor parent-child relationships, childhood anxiety disorders, marital problems, low educational attainment and low social support.


"Initially, we thought that the pathway to depression through acting out behaviors such as conduct disorder and drug use and abuse would be significantly more important in men than in women. But we found that there are only very modest differences," said Kenneth S. Kendler, a professor of psychiatry and human genetics in VCU's School of Medicine and lead author on the study.


In 2002, Kendler and his team presented a developmental model to assess major depression in women. Using similar methods, they presented an analogous model to assess depression in men. For this study, approximately 3,000 adult male twins from the Virginia Twin Registry were interviewed twice during a two- to -four-year period. Data collected from this population was compared to the results obtained from the 2002 study on women. The Virginia Twin Registry, now part of the VCU Mid-Atlantic Twin Registry (MATR), contains a population-based record of twins from Virginia, North Carolina and South Carolina.


According to Kendler, one difference observed was that childhood parental loss and low self-esteem were more potent variables in men than in women.


This work was supported by grants from the National Institutes of Health.


Kendler collaborated with VCU researchers Charles O. Gardener, Ph.D., and Carol A. Prescott, Ph.D.


About VCU and the VCU Medical Center: Located on two downtown campuses in Richmond, Va., Virginia Commonwealth University is ranked nationally by the Carnegie Foundation as a top research institution and enrolls more than 29,000 students in more than 181 certificate, undergraduate, graduate, professional and doctoral programs in the arts, sciences and humanities in 15 schools and one college. Forty of the university's programs are unique in Virginia, and 20 graduate and professional programs have been ranked by U.S. News & World Report as among the best of their kind. MCV Hospitals, clinics and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the leading academic medical centers in the country. For more, see vcu .


Sathya Achia-Abraham

sbachiavcu

Virginia Commonwealth University

vcu

PTSD Influences Levels Of Depression And Pain

Patients with accident or trauma related chronic pain often have post-traumatic stress disorder (PTSD) and depression. What isn't clearly known, however, is how PTSD relates to mood disorders and pain severity in chronic pain patients.


University of Michigan researchers examined the contribution of PTSD to the pain experience, functional disability and frequency of depressive symptoms. They studied 241 patients referred to the university hospital's pain rehabilitation program who reported their pain began after a traumatic injury. The subjects completed the McGill Pain Questionnaire and were administered the Pain Disability Index and the Post-traumatic Chronic Pain Test.


Results showed PTSD and depression are significantly correlated and both disorders are associated with perceived disability attributed to chronic pain. Therefore, in cases of disabling accident-related chronic pain with comorbid depression, symptoms of PTSD may be critical to understanding both disorders. The authors concluded that increased attention to treating PTSD as a primary focus in the rehabilitation of patients with chronic pain and comorbid depression is important when prior treatment efforts for pain and depression have not been successful.


American Pain Society

4700 W. Lake Ave.

Glenview, IL 60025

United States

ampainsoc

Recognizing Depression And Getting Help

The change of seasons and the approach of National Depression Awareness Week, Oct. 2-9, make this a good time to re-examine the impact of depression, a serious illness that affects as many as 20 million adult Americans each year, along with their friends and loved ones. According to Dr. Kelly Miller of the University of Indianapolis Health and Counseling Center, this common mental health condition is subject to misconceptions that often keep people from seeking the help they need. The goal of the annual awareness observance is to dispel those myths and assist individuals in recognizing and understanding depression.


Myth: Depression is a personal or moral weakness.


Fact: Depression is an illness with no single cause. Heredity, chemical changes in the body, and significant life changes or stressors all can lead to a depressive episode.


Myth: Depression is only extreme sadness - "Snap out of it!"


Fact: Depression is more than sadness or having the "blues." Symptoms of depression are much more pervasive and chronic and can lead to significant impairment in one or more areas of life.


Myth: Depressed people are lazy or looking for attention.


Fact: Actually, people with depression may attempt to hide their distress from others. Encourage them to talk about their depression and seek the help they need.


Warning signs of depression


Five or more can indicate clinical depression, most experts say


-- Persistent sad, anxious or "empty" mood

-- Loss of interest or pleasure in activities once found enjoyable

-- Feelings of hopelessness, worthlessness or excessive guilt

-- Fatigue or loss of energy

-- Sleeping too little or too much

-- Difficulty making decisions or diminished ability to concentrate

-- Significant weight loss or weight gain when not dieting

-- Suicidal thoughts or plans


Tips for recovery


-- Recognize that depression is a treatable illness and seek appropriate treatment

-- Talk to friends and family about your depression and let them help you

-- Take part in some form of regular physical activity and exercise

-- Recognize that recovery takes time; focus on the improvements you are making

-- Curb the negative self-talk; what we say to ourselves influences our feelings

-- Break large tasks into small ones and set realistic goals

-- Postpone important decisions until the depression has lifted


University of Indianapolis

1400 E. Hanna Ave.

Indianapolis, IN 46227-3697

United States


University of Indianapolis

People with mild depression are more tuned into the feelings of others

Surprisingly, people with mild depression are actually more tuned into the feelings of others than those who aren't depressed, a team of Queen's psychologists has discovered.


"This was quite unexpected because we tend to think that the opposite is true," says lead researcher Kate Harkness. "For example, people with depression are more likely to have problems in a number of social areas."


The researchers were so taken aback by the findings, they decided to replicate the study with another group of participants. The second study produced the same results: People with mild symptoms of depression pay more attention to details of their social environment than those who are not depressed.


Their report on what is known as "mental state decoding" - or identifying other people's emotional states from social cues such as eye expressions - is published today in the international journal, Cognition and Emotion.


Also on the research team from the Queen's Psychology Department are Professors Mark Sabbagh and Jill Jacobson, and students Neeta Chowdrey and Tina Chen. Drs. Roumen Milev and Michela David at Providence Continuing Care Centre, Mental Health Services, collaborated on the study as well.


Previous related research by the Queen's investigators has been conducted on people diagnosed with clinical depression. In this case, the clinically depressed participants performed much worse on tests of mental state decoding than people who weren't depressed.


To explain the apparent discrepancy between those with mild and clinical depression, the researchers suggest that becoming mildly depressed (dysphoric) can heighten concern about your surroundings. "People with mild levels of depression may initially experience feelings of helplessness, and a desire to regain control of their social world," says Dr. Harkness. "They might be specially motivated to scan their environment in a very detailed way, to find subtle social cues indicating what others are thinking and feeling."


The idea that mild depression differs from clinical depression is a controversial one, the psychologist adds. Although it is often viewed as a continuum, she believes that depression may also contain thresholds such as the one identified in this study. "Once you pass the threshold, you're into something very different," she says.


Funding for this study comes from a New Opportunities Grant from the Canada Foundation for Innovation.


Nancy Dorrane

dorrancepost.queensu.ca

Queen's University

queensu.ca

Studies Suggest Parental Monitoring Can Help Decrease Adolescent Marijuana Use

Marijuana is the most widely used illicit drug by adolescents, with almost 42% of high school seniors admitting to having experimented with it. Continued marijuana use may result in a number of serious consequences including depression, cognitive impairment, cardiovascular disease, and certain forms of cancer. As such, it is critical to prevent marijuana use by adolescents and numerous behavioral and medical scientists have been trying to establish the best means of prevention.



Many studies have focused on parents as being the best avenue for preventing adolescent marijuana use. Specifically, parental monitoring (when the parents know where their children are, who they are with, and what they are doing) has been seen as attenuating a number of negative adolescent behaviors, including gambling, sexual activity, and drug use. However, the strength of the relationship between monitoring and marijuana usage has been unclear; for example, if adolescents use marijuana, they may be more likely to hide that from their parents, compared to other behaviors. Despite this uncertainty, millions of dollars are spent annually on programs and media campaigns that urge parents to monitor their children's behavior.



Psychologists Andrew Lac and William Crano from Claremont Graduate University reviewed numerous studies to examine the connection between parental monitoring and adolescent marijuana use. For this review, Lac and Crano selected 17 studies from the literature, which contained data on over 35,000 participants. Criteria the researchers used for selecting studies included adolescent participants, that the research focused exclusively on marijuana, and that parental monitoring was evaluated by adolescent self-reports, not parents' reports of their own monitoring behavior.



Results of this comprehensive analysis, reported in the current issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, reveal that there is in a fact a strong, reliable link between parental monitoring and decreased marijuana usage in adolescents. In addition, the strongest effects were seen in the female-only studies.



The authors note, "Our review suggests that parents are far from irrelevant, even when it comes to an illegal and often secretive behavior on the part of their children." They conclude that the information gleaned from this analysis may be useful for marijuana-based prevention programs that target parents and might provide some insight into alleviating risky adolescent behavior.

Hearts & Minds: NAMI Highlights Meditation, Yoga And Other "Mindfulness" Practices For Mental Illness

The National Alliance on Mental Illness (NAMI) is providing a new dimension to its Hearts & Minds initiative, an educational program that promotes "mind and body" health practices for individuals who live with mental illness.


A new "Mindfulness" section on NAMI's Hearts and Minds website includes a 10-minute video of guided mediation, along with information about other holistic methods to complement medication and therapy and help a person to gain greater control over the recovery process.


Practices covered include basic meditation, guided imagery, yoga and Tai Chi, and creative outlets such as writing, art, music and dance.


Ed Knight of ? says he uses meditation to help control hearing voices and panic attacks: "Without the combination of meditation and medication, I would be in and out of the hospital very frequently. I haven't had a panic attack in several years and I have ceased to hear voices."


"Medication and therapy are crucial to recovery, but everyone's experience is different," said NAMI Executive Director Michael Fitzpatrick. "Hearts and Minds offers a holistic dimension for managing? mental illness . Some practices will work for some people, but not for everyone. In the end it comes down to what works for you."


"Outlets for self-awareness exist in every state and local unity. They can be pursued individually or in groups. Every outlet can make a contribution to recovery," Fitzpatrick said.


Mental illnesses include major depression, bipolar disorder, schizophrenia and other diagnoses.

Implantable Pacemaker-like Device Sends Pulses to the Brain via Nerve in the Neck to Treat Chronic Depression

Psychiatrists at Rush University Medical Center are the first in Chicago to use a vagus nerve stimulator (VNS), an implantable, pacemaker-like device, as a therapy to treat long-term, treatment-resistant depression (TRD) in adults. Dr. John Zajecka led the VNS therapy clinical trial at Rush.


The procedure to place the device, which is usually performed under general anesthesia on an outpatient basis, takes about an hour. Two small incisions are required: one on the upper chest area for the pulse generator and one on the left neck for the thin, flexible wires that connect the pulse generator to the vagus nerve. The incisions heal in one to two weeks, and the scars fade over time. The neck scar is usually located within a natural crease of the neck and is therefore not very visible.


"The pulse generator, which is like a pacemaker, is implanted in the chest area and sends mild pulses to the brain via the vagus nerve in the neck. A thin, thread-like wire attached to the generator, runs under the skin to the left vagus nerve. The vagus nerve, one of the 12 cranial nerves, serves as the body's 'information highway' connecting the brain to many major organs," said Zajecka.


The device delivers very mild, intermittent, brief pulses to the left vagus nerve. The pulses are then transmitted via the nerve to the central nervous system, to specific areas in the central nervous system that control mood, motivation, sleep, appetite, and other symptoms that are relevant to depression. Several studies have shown that VNS Therapy may modulate neurotransmitters such as serotonin and norepinephrine thought to be involved in mood regulation, according to Zajecka.


VNS Therapy is approved by the Food and Drug Administration as a long-term adjunctive (add-on) treatment for patients 18 years of age and older who are experiencing a major depressive episode and have not had an adequate response to four or more antidepressant treatments. VNS Therapy was approved for the treatment for some patients with epilepsy in 1997, and is now the first treatment specifically studied and approved for treatment-resistant depression.


Major depressive disorder is one of the most prevalent and serious illnesses in the U.S., affecting nearly 19 million Americans every year. Of those, 20 percent, or approximately four million people, experience depression that does not respond to multiple antidepressant treatments. For these people, treatment may attempts may have included psychotherapy, antidepressant medications and sometimes electro-convulsive therapy, but they are effective for a short while and stop working over time.


"Patients with TRD need additional options," said Zajecka. "The availability of VNS Therapy is an important treatment option for millions of people who, until now, have not had access to a proven long-term option to control depressive symptoms. It is especially important to know that clinical study results have shown that patients achieve increasing benefits from VNS Therapy over time and experience sustained results. Additionally, VNS Therapy is very tolerable, and side effects typically diminish over time." Three percent of patients in the clinical trial experienced side effects of incision pain; voice alteration; incision site redness/itching, pain around the device and swelling and tenderness.


Zajecka says that in clinical studies of VNS Therapy, more than half of the patients who had experienced an average of 25 years of major depressive disorder and multiple treatment trials realized some clinical benefit, one third of the patients had at least a 50 percent improvement in their depression. One out of six patients were depression-free after one to two years of treatment with VNS Therapy. Patients also reported significant improvements in quality-of-life areas, such as vitality, mental health, emotional well-being and social functioning.


Patients seeking more information should call (888) 352-RUSH(7874).


Rush University

Depression Screening For Cancer Patients Too Often Falls Between The Cracks

Depression is known to be associated with cancer yet too many cancer patients are not screened for this mental disorder, according to researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Roudebush VA Medical Center.


In a study published in the November-December issue of General Hospital Psychiatry, Caroline Carney Doebbeling, M.D., M.Sc. and Laura Jones, Ph.D., looked at data from the Roudebush VA Medical Center, where 95 percent of veterans in primary care are screened for depression.


They report that depression screening in cancer patients was not done nearly as frequently with, for example, only slightly over half of veterans with lung cancer receiving screening. "In places without integrated care and mandated primary care depression screening like the VA, we speculate that screening rates are even worse," said Dr. Carney Doebbeling, associate professor of medicine and of psychiatry at the Indiana University School of Medicine and a Regenstrief Institute research scientist.


Lung cancer has one of the highest associations with depression of any cancer, according to Dr. Doebbeling, who is an internist and a psychiatrist. Many lung cancer patients have a history of smoking which has a strong association with depression and anxiety disorders.


"In any clinical setting, the cancer care provider needs to care for the patient's mental as well as physical needs through the course of treatment. Once cancer develops, an individual who is depressed may be less likely to be adherent to their cancer therapy regimen as has been shown in other conditions like heart disease and diabetes. This issue has not yet been sufficiently studied in cancer yet," says Dr. Carney Doebbeling. "What is clear is that cancer patients treated for depression report a better quality of life during the course of treatment. This comes back around to the need to screen and recognize depression early on."


Why do doctors fail to screen cancer patients for depression? "When doctors think their patients have a higher risk of mortality, depression screening is not as big a focus. Clinicians need to be made aware that depression screening is important even in end-stage cancer," said Dr. Jones, who is with the Roudebush VA Medical Center's Center of Excellence on Implementing Evidence-Based Practice and is a health services researcher.


Dr. Carney Doebbeling adds, "Cancer survivorship is an especially difficult experience if you are depressed. If we as clinicians don't have long-term awareness of patients' depression how can we expect them to do well through the course of their treatment and beyond, no matter how long they have post treatment?"


Indiana University School of Medicine

Increase in heart surgery mortality from SSRIs or depression?

Duke University Medical Center researchers have found that patients who were using a class of anti-depression drugs
known as selective serotonin reuptake inhibitors (SSRI) prior to undergoing coronary artery bypass surgery have significantly
higher death and rehospitalization rates up to five years after the procedure than patients who were not on SSRIs.


The researchers said that, based on the results of their analysis of more than 4,700 heart patients, that physicians treating
heart surgery patients should not only screen for depression prior to surgery, but that they should also pay closer attention
to the long-term psychiatric care of patients deemed to be depressed.


"While many studies have shown that depression is just as important a cardiac risk factor as hypertension and smoking, there
are still many in the field who do not fully appreciate this mind-body link," said Glen Xiong, M.D., who presented the
results of the Duke study May 25, 2005, during the annual scientific sessions of the American Psychiatric Association in
Atlanta.


"This under-appreciation may be because of the stigma associated with mental health issues," said Xiong, a resident in Duke's
Medicine-Psychiatry program. "Many think that patients who have just had a heart attack are depressed and that with time,
they'll get over it. Our study would indicate that these are the very patients who need to be followed more closely."



Their analysis of 4,794 heart surgery patients at Duke from 1999 to 2003 found that 5.1 percent of patients were taking SSRIs
prior to surgery. When the researchers then checked survival rates four years later, they found that 75.1 percent of patients
taking SSRIs were still alive, compared to 84.9 percent who weren't taking SSRIs.


"However, when we looked at the 30 days mortality following the operation, both groups were about the same," Xiong said.
"It's only when patients get farther out from surgery that the mortality rates begin to increase among patients who were
taking SSRIs prior to the heart surgery. We believe that this increase is due more to the underlying depression itself than
medication use. It appears that for our study, SSRI usage serves as a marker for the depressed patients."


The researchers added that depression is associated with many physiological and psychosocial characteristics that likely
explain why depressed patients tend to fare worse over time.


The researchers also found that those patients taking SSRIs were as a group significantly more often white than those who
were not (85.8 percent vs. 76.2 percent) and female (43.9 percent vs. 29 percent). The SSRI group also was more likely to
have diabetes, high blood pressure and increased cholesterol levels when compared to the non-SSRI group.















"We also know that depressed patients are less likely to take their medications, go to the doctor or rehab program regularly,
eat healthy diets or stop smoking," Xiong continued. "It is precisely for these reasons we believe that these high-risk
surgery patients need to receive appropriate treatment for depression."


"In our cohort of patients, only five percent were taking SSRIs, which we believe greatly under-represents the number of
depressed heart patients," said Duke internist and psychiatrist Wei Jiang, M.D., Xiong's mentor and a senior member of the
research team. "Nationally, it is believed that up to twenty percent of heart patients are depressed. This raises that
concern that many depressed patients are being under-treated for their depression, and that we can save lives if we identify
and treat depression appropriately."


"In many ways, this study raises more questions than it answers," Jiang continued. "It raises questions of how we treat
depression in hearts disease - we need to see it as a long-term, chronic condition. I think we need to conduct longer-term
studies to see if anti-depression medications and psychotherapy can influence the mortality rates for these patients."



Xiong added: "Just as importantly, we need to see if we should introduce a depression screening tool in our standard
treatment for patients with heart disease. Should we be screening and monitoring for depression more regularly, like we do
for hypertension and hypercholesterolemia?"


The study was supported by Duke's Department of Psychiatry and the Duke Clinical Research Institute.


Other members of the Duke team were Kristin Newby, M.D., Bob Clare, Linda Shaw, Peter Smith M.D., Kenneth Mahaffey, M.D.,
Chris O'Connor, M.D. and Ranga Krishnan, M.D.


Contact: Richard Merritt

Merri006mc.duke

919-684-4148

Duke University Medical Center

dukemednews

Psychotic Major Depression - 3rd Phase III Trial of CORLUX(R), Corcept Therapeutics

Corcept Therapeutics
Incorporated today announced that it has initiated its third
Phase III clinical trial designed to evaluate the safety and efficacy of
CORLUX(R) (mifepristone) for the treatment of the psychotic features of
psychotic major depression (PMD). CORLUX has been granted Fast Track
designation for this indication. Corcept anticipates having initial results
from this study available by the end of 2006. Results from the company's two
ongoing Phase III trials are expected to be reported during the first half of
2006.


"We are pleased to have begun the third Phase III trial for our lead
development program," said Dr. Joseph K. Belanoff, Corcept's chief executive
officer. "PMD is a disorder that affects approximately three million people
in the United States each year and for which there are no FDA-approved
treatments. We look forward to determining the efficacy and safety of CORLUX.
Through these studies, we are investigating whether CORLUX provides rapid and
sustained relief from the psychotic symptoms of this severe illness."


Clinical Trial Design


The primary endpoint for this randomized, double-blind, placebo-controlled
Phase III clinical trial of CORLUX, known as Corcept 09, is the proportion of
patients with at least a 50% improvement in the Brief Psychiatric Rating Scale
Positive Symptom Subscale (BPRS PSS) at both Day 7 and Day 28. A secondary
endpoint is a 50% or greater improvement in BPRS PSS at both Day 7 and Day 56,
which is identical to the primary endpoints of the company's other two ongoing
Phase III studies. The BPRS is an 18-item rating instrument used to assess
psychopathology and the PSS includes the four items in the BPRS that
specifically measure psychosis. In all three trials, patients must have at
least mild psychotic symptoms (BPRS PSS greater than or equal to 12) to enter
the studies and will be hospitalized if clinically necessary. BPRS PSS
assessments will also be made at Days 14, 28 and 42.


Corcept 09 is the company's first study to be conducted in Europe. This
study will enroll up to 280 patients at approximately 15 sites in Croatia,
Bulgaria and Serbia with a randomized one-to-one distribution into either a
CORLUX or a placebo arm. Patients will receive either 600 mg of CORLUX or
placebo once daily for a period of seven days. Concurrent with the first day
of dosing, all patients will receive antidepressant therapy through Day 56. No
patient will be allowed to take either antidepressant or antipsychotic
medication for at least one week before beginning the seven day treatment
period. Treatment with antipsychotic medications or electroconvulsive therapy
will not be allowed at any time during the study


Previously completed trials


The Company has completed four studies of CORLUX for the treatment of
psychotic features of PMD. In January 2001, a dose finding clinical trial
evaluating the efficacy, tolerability and dose response of CORLUX showed that
after one week of treatment, approximately two-thirds of the patients in the
two higher dosage groups (600 mg and 1200 mg) experienced clinically
meaningful reductions in psychosis, as measured by the BPRS. Based on these
encouraging results, the Company conducted two clinical trials, the 02 study
and 03 study, which were double-blind, placebo-controlled safety and efficacy
studies in which a total of 429 patients were enrolled.















The 02 study showed that CORLUX was well tolerated and that there were no
discernible problems with drug interactions between CORLUX and commonly
prescribed antipsychotic and antidepressant medications. The 03 study
demonstrated with statistical significance that patients in the CORLUX group
were more likely than patients in the placebo group to achieve a 50% reduction
in the BPRS PSS at Day 7 sustained to Day 28. In a fourth trial, an open label
study of the safety of retreatment in patients with a favorable response to
treatment in the 02 and 03 studies, it was indicated that patients tolerated
their retreatment well. Twenty-eight patients participated in this study.


About Psychotic Major Depression


PMD is a serious psychiatric disorder that affects approximately three
million people annually in the United States. It is more prevalent than either
schizophrenia or manic depressive illness. The disorder is characterized by
severe depression accompanied by delusions, hallucinations or both. People
with PMD are approximately 70 times more likely to commit suicide than the
general population and often require lengthy and expensive hospital stays.
There is no FDA-approved treatment for PMD.


About Corcept Therapeutics Incorporated


Corcept Therapeutics Incorporated is a pharmaceutical company engaged in
the development of drugs for the treatment of severe psychiatric and
neurological diseases. Corcept's lead product candidate, CORLUX, is currently
in Phase III clinical trials for the treatment of the psychotic features of
PMD. The drug is administered orally to PMD patients once per day for seven
days. CORLUX, a potent GR-II antagonist, appears to mitigate the effects of
the elevated and abnormal release patterns of cortisol seen in PMD. For
additional information about the company, please visit corcept.


Forward Looking Statements


Statements made in this news release, other than statements of historical
fact, are forward-looking statements, including, for example, statements
relating to our PMD clinical development program, FDA agreements and the
completion of Phase III trials. Forward-looking statements are subject to a
number of known and unknown risks and uncertainties which might cause actual
results to differ materially from those expressed or implied by such
statements. For example, there can be no assurances with respect to the,
efficacy, safety, completion or success of clinical trials, there can be no
assurances with respect to the regulatory process or regulatory approvals,
there can be no assurances with respect to commercial success, and trial
timetables may not be accurate. Risk factors are set forth in the Company's
SEC filings, all of which are available from our website (corcept) or
from the SEC's website ( sec ). We disclaim any intention or
duty to
update any forward-looking statement made in this news release.


Corcept Therapeutics Incorporated

corcept

Can Weight Be Related To Recurrent Depression And Its Treatment With Antidepressants Drugs?

This study demonstrates that patients using antidepressants (Ads) continuously, mostly serotonin-selective reuptake inhibitors (SSRIs), show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures.


In a study published in the last 2010 issue of Psychotherapy and Psychosomatics, a group of researchers of the University of Amsterdam presents new findings on the relationship between weight and recurrent depression.


The literature on the relation between obesity and the recurrent type of major depressive disorder (MDD-R; having had at least 2 major depressive episodes) is limited and equivocal. Most studies on depression and obesity did not distinguish between single and recurrent episodes. However, this distinction may be important because depression is increasingly considered a chronic recurrent disorder with various levels of interepisodic functioning, and evidence is growing that the recurrent type is a distinct one.


Most studies on the relation between depression and obesity did not control for antidepressant (AD) medication use, although a substantial part (20 - 60%) of the recurrently depressed patients use ADs for lengthy periods of time. This study elaborates on their findings by focussing on the relation between obesity and MDD-R and the association between long-term use of ADs and obesity. To be eligible for this study, ppatients had to meet the following criteria: (a) at least 2 major depressive episodes in the past 5 years (DSM IV), (b) current remission status, according to DSM-IV criteria, for longer than 10 weeks and no longer than 2 years before, and (c) Hamilton Rating Scale for Depression of

National Study Offers New Insight On How Physicians Prescribe Psychiatric Drugs

A new study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) outlines the conditions that physicians around the country reported treating with psychiatric drugs such as antipsychotics, antidepressants, and anti-anxiety drugs.


Psychiatric medications are one of the most widely prescribed categories of drugs in the nation; yet few studies have comprehensively examined the types of illnesses being treated with these medications. In particular, there has been a great deal of interest and some concern about how psychiatric drugs are being prescribed for medical conditions not included in their Food and Drug Administration-approved labeling - or "off-label" -- use. In most instances it is legal and a common practice for physicians to prescribe drugs off-label, even though less may be known about a drug's risks and benefits for an unapproved indication.


Although this study did not evaluate whether drugs were prescribed for on- or off-label use, the study reveals that in the vast majority of cases physicians are prescribing psychiatric medications for patients with psychiatric conditions. These medications are also sometimes prescribed to treat other conditions. This is particularly true in the case of anti-anxiety drugs.


"From this study it seems clear that psychiatric medications are for the most part being prescribed for treating people with psychiatric conditions," said SAMHSA Administrator Pamela S. Hyde, J.D. "Yet, as clinicians broaden their use of psychiatric medications to a variety of mental illnesses, research and education are needed to ensure that the uses are appropriate."


The study looked at the prescription patterns for three major types of psychiatric drugs: antipsychotic drugs, antidepressant drugs, and anti-anxiety drugs, but did not evaluate clinical appropriateness per se.


The study found that antipsychotic drugs were prescribed for psychiatric conditions 99 percent of the time, including mood disorders (39 percent), schizophrenia or other psychotic disorders (35 percent), cognitive disorders such as dementia (7.4 percent), anxiety (6 percent), and attention-deficit/conduct-disruptive behavior disorders (6 percent).


In terms of antidepressant drugs, the study found that 93 percent of prescriptions were for psychiatric conditions, primarily mood disorders (65 percent), anxiety (16 percent), schizophrenia, and other psychotic disorders (2.6 percent). Other non-psychiatric diagnoses for which antidepressants were prescribed included headaches (1.1 percent), connective tissue disease (e.g., fibromyalgia) (1 percent), and back problems (0.7 percent).


Although the study found that the majority of prescriptions written for anti-anxiety medication were used to treat psychiatric conditions (72 percent), a significant percentage (28 percent) were used to for non-psychiatric diagnoses including anxiety related to medical interventions (6 percent), allergic reactions (4 percent), and back problems (2.5 percent).



The study, conducted by Tami L. Mark, Ph.D. at Thomson Reuters and published in the journal CNS Drugs analyzed data from the 2005 National Disease and Therapeutic Index, a nationally representative survey of about 4,000 U.S. office-based physicians conducted by IMS Health.


Source
Substance Abuse and Mental Health Administration (SAMHSA)

The Largest Clinical Study Ever Conducted On Treating Depression With Omega-3 Shows Encouraging Results

The use of Omega-3 supplements is effective among patients with major depression who do not have anxiety disorders, according to a study directed by Dr. Francois Lesperance of the Centre de recherche du Centre hospitalier at the Universite de Montreal (CRCHUM), head of CHUM's Department of Psychiatry and a professor at the Universit?© de Montreal. The study was published in the online Journal of Clinical Psychiatry.



This was the largest study ever conducted assessing Omega-3's efficacy in treating major depression. It was carried out in conjunction with researchers from centres affiliated with the UdM's R?©seau universitaire int?©gr?© de sant?© (RUIS), from McGill University, Universit?© Laval in Quebec City and Queen's University in Kingston, Ontario. The study was supported by the European firm isodisnatura, the Fondation du CHUM and the CRCHUM.



Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder. Efficacy for these patients was comparable to that generally observed with conventional antidepressant treatment.



From October 2005 to January 2009, 432 male and female participants with major unipolar depression were recruited to take part in this randomized, double-blind study (neither patients nor researchers knew which capsules patients received). For eight weeks, half of the participants took three capsules per day of OM3 Emotional Balance, a fish oil supplement containing high concentrations of eicosapentaenoic acid (EPA). The other half took three identical capsules of a placebo consisting of sunflower oil, flavoured with a small quantity of fish oil. In contrast with typical clinical studies designed to assess the effectiveness of antidepressants, this study included a high proportion of patients with complex and difficult-to-treat conditions, including patients resistant to conventional antidepressant treatments and patients also suffering from an anxiety disorder. The aim was to assess the value of Omega-3 supplementation in a group of individuals more like those treated in outpatient clinics.



Need to assess the impact of Omega-3 supplements



Some 11% of men and 16% of women in Canada will suffer from major depression at some point in their lives, making this disorder one of our society's leading public health issues. Depression, which is now the world's fourth leading cause of morbidity and death is expected to move up to the number two position by 2020. "Despite significant progress in neuroscience over the past two decades, depression is difficult to treat," Dr. Lesp?©rance noted. In view of the large number of patients who stop taking their medications in the first few months of treatment and those who refuse such treatment due to fear of stigmatization or side effects, it comes as no surprise that a large number of patients suffering from major depression use alternative treatments offered outside the healthcare system. "Many of these treatments have not been adequately evaluated. That is why it was important to assess the efficacy of Omega-3, one of the most popular alternative approaches," he added.
















Epidemiological and neurobiological studies have suggested that a relative deficit in polyunsaturated fatty acids of the Omega-3 group may predispose individuals to psychological disorders such as depression. Further, several preliminary clinical studies based on small numbers of patients have suggested that Omega-3 supplements with high concentrations of EPA can help to reduce symptoms of depression among patients who fail to respond to an initial antidepressant treatment. These studies have not, however, convinced the entire scientific community. A broader study was needed to acquire further knowledge about the properties and efficacy of high-quality Omega-3 supplements among patients suffering from major depression.



"We are proud that OM3 Emotional Balance, with its high concentration of EPA at unexcelled levels of purity delivers the dose of EPA needed for effective treatment," said Claire Bertin, head pharmacist for isodisnatura, the laboratory producing the Omega-3 supplement used in the study.



It is important to note that the study assessed use of Omega-3 for eight weeks, at doses of 1050 mg of EPA and 150 mg of DHA each day. It is currently unknown whether taking higher doses or taking supplements over a longer period would yield different results.



These encouraging results show that use of EPA is effective among patients with unipolar depression unaccompanied by an anxiety disorder. Additional research directly comparing Omega-3 with conventional antidepressants could more clearly confirm their usefulness for patients suffering from depression.



The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial, The Journal of Clinical Psychiatry - Fran?§ois Lesp?©rance, MD, PhD; Nancy Frasure-Smith, PhD; ?‰lise St-Andr?©, MD; Gustavo Turecki, MD, PhD; Paul Lesp?©rance, MD, MSc; and Stephen R. Wisniewski, PhD.

Therapeutic Lifestyle Changes Offer Many Mental Health Benefits

Lifestyle changes - such as getting more exercise, time in nature, or helping others - can be as effective as drugs or counseling to treat an array of mental illnesses, according to a new paper published by the American Psychological Association.



Multiple mental health conditions, including depression and anxiety, can be treated with certain lifestyle changes as successfully as diseases such as diabetes and obesity, according to Roger Walsh, M.D., PhD. of the University of California, Irvine's College of Medicine. Walsh reviewed research on the effects of what he calls "therapeutic lifestyle changes," or TLCs, including exercise, nutrition and diet, relationships, recreation, relaxation and stress management, religious or spiritual involvement, spending time in nature, and service to others. His paper was published in American Psychologist, APA's flagship journal.



Walsh reviewed research on TLCs' effectiveness and advantages, as well as the psychological costs of spending too much time in front of the TV or computer screen, not getting outdoors enough, and becoming socially isolated. He concludes that "Lifestyle changes can offer significant therapeutic advantages for patients, therapists, and societies, yet are insufficiently appreciated, taught or utilized," The paper describes TLCs as effective, inexpensive and often enjoyable, with fewer side effects and complications than medications. "In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical and public health," Walsh said.



According to research reviewed in the paper, the many often unrecognized TLC benefits include:
Exercise not only helps people feel better by reducing anxiety and depression. It can help children do better in school, improve cognitive performance in adults, reduce age-related memory loss in the elderly, and increase new neuron formation in the brain.
Diets rich in vegetables, fruits and fish may help school performance in children, maintain cognitive functions in adults, as well as reduce symptoms in affective and schizophrenic disorders.
Spending time in nature can promote cognitive functions and overall well-being.
Good relationships can reduce health risks ranging from the common cold to strokes as well as multiple mental illnesses, and can enhance psychological well-being dramatically.
Recreation and fun can reduce defensiveness and foster social skills.
Relaxation and stress management can treat a variety of anxiety, insomnia, and panic disorders.
Meditation has many benefits. It can improve empathy, sensitivity and emotional stability, reduce stress and burnout, and enhance cognitive function and even brain size.
Religious and spiritual involvement that focuses on love and forgiveness can reduce anxiety, depression and substance abuse, and foster well-being.
Contribution and service, or altruism, can enhance joy and generosity by producing a "helper's high." Altruism also benefits both physical and mental health, and perhaps even extends lifespan. A major exception the paper notes is "caretaker burnout experienced by overwhelmed family members caring for a demented spouse or parent."

Difficulties associated with using TLCs are the sustained effort they require, and "a passive expectation that healing comes from an outside authority or a pill," according to Walsh. He also noted that people today must contend with a daily barrage of psychologically sophisticated advertisements promoting unhealthy lifestyle behaviors such as smoking, drinking alcohol, and eating fast food. "You can never get enough of what you don't really want, but you can certainly ruin your life and health trying" lamented Walsh.
















For therapists, the study recommends learning more about the benefits of TLCs, and devoting more time to foster patients' TLCs.



The paper recognizes that encouraging widespread adoption of therapeutic lifestyles by the public is likely to require wide-scale measures encompassing educational, mental, and public health systems, as well as political leadership.



Article: "Lifestyle and Mental Health," Roger Walsh, PhD, M.D., University of California College of Medicine, Irvine; American Psychologist, Online First Publication, January 17, 2011.

Link Between Key Protein Molecule And Diverse Human Chronic Inflammatory Diseases

Liwu Li, associate professor of biological sciences at Virginia Tech, has revealed a common connection between the cellular innate immunity network and human chronic inflammatory diseases, including atherosclerosis, Type 2 Diabetes, and neurodegenerative diseases. The finding presents a viable cellular and molecular target for the diagnosis and treatment of serious human inflammatory diseases, according to Li.



"Researchers and physicians have long recognized that there is an association between these conditions. For example, obesity increases the risk of heart attack or stroke, Type 2 Diabetes or insulin resistance, and Alzheimer's Disease," said Li, who is the founding director of the Inflammation Center at Virginia Tech.



"Inflammation is the common mechanism," he said. "Inflammation is a double-edged sword. Proper inflammation is necessary to fend off infection and abnormal cell growth. On the other hand, excessive inflammation contributes to diverse chronic diseases, including atherosclerosis, diabetes, and lupus." However, the complex cellular and molecular networks controlling inflammation are still poorly understood, he said. "The lack of understanding impedes our progress in treating serious chronic inflammatory diseases."



In a series of studies published throughout the last decade*, Li's group has defined several critical signaling networks essential for the modulation of inflammation. In particular, a key cellular protein kinase named interlukin-1 receptor associated kinase 1 (IRAK-1) was shown to be critical for processing diverse inflammatory signals, including microbial products, cytokines, and insulin. Li's group discovered that excessive IRAK-1 activation is linked with the risk of atherosclerosis and diabetes. Using transgenic mice without the IRAK-1 gene, Li's group demonstrated that IRAK-1 deficient mice are protected from developing atherosclerosis and insulin resistance.



At the molecular level, Li's laboratory discovered that IRAK-1 prefers to phosphorylate transcription factors harboring the Serine-Proline motif including STAT-3 and NFAT. Subsequently, STAT-3 and NFAT are involved in modulating the expression of distinct inflammatory mediators responsible for the excessive activation of specialized macrophages and T cells. These cells eventually contribute to diverse inflammatory symptoms including cardiovascular diseases, diabetes, Alzheimer's diseases, and lupus. "Chemical compounds targeting this molecule will have enormous therapeutic potential," Li said.



"There is still a long way to go for finding the actual cure for these diseases," he said. "That is why we are combining expertise from various disciplines, including experimental biology and computational simulation. The Inflammation Center integrates faculties with expertise in experimental molecular biology, cutting edge imaging of inflamed cells and tissues, computational simulation of cellular signaling networks, human and animal studies, and nano-technologies designing novel intervention."



Virginia Tech Intellectual Properties Inc. (VTIP) filed a patent application for Li's discovery and its use as a diagnostic tool and treatment strategy. "This technology will still take some time before there is a product," said Li.







Li's research is funded by the National Institutes of Health.



*The most recent publication from Li's group appeared in the September 2008 issue of Molecular Immunology, "The interleukin-1 receptor associated kinase 1 contributes to the regulation of NFAT," by Dongmei Wang, Stephan Fasciano, Liwu Li (available online Aug. 8, 2008.), pages 3902-3908.



Learn more about Li's research at: biology.vt/faculty/li



For more information about the patent, visit: vtip/availableTech/technology.php?id=185933li

Treating Women's Depression Might Help Them Lose Weight

For many women coping with obesity and depression, new research finds that improving your mood might be the link to losing weight.


The new study, which appears in the November/December issue of the journal General Hospital Psychiatry, cites past surveys that show having a body mass index (BMI) of 30 or more - classified as obese - increases a person's risk of depression by 50 percent to 150 percent.


"I expect that the relationship between depression and physical activity goes in both directions," said lead author Gregory Simon, M.D., of Group Health Research Institute in Seattle. "Increased physical activity leads to improvement in depression and improvement in depression leads to increased physical activity. We see in our study that they go together, but we can't say which causes which."


Simon and his colleagues evaluated 203 women ages 40 to 65 with an average BMI of 38.3. Participants underwent baseline tests to measure their weight, depression score, physical activity and food intake.


They placed the women into two treatment groups - one focused on weight loss and the other focused on both weight loss and depression. Both interventions included up to 26 group sessions over 12 months, and researchers followed up on participants at six, 12 and 24 months after enrollment.


The researchers found the most significant changes happened in the first six months and then remained stable afterwards. At six months, among the women who had at least a one-half point decrease on the Hopkins Symptom Checklist depression score, 38 percent lost at least 5 percent of their body weight. This compared with 21 percent of the women who lost the same amount but had no decrease - or an increase - in their depression score.


"Most weight loss programs do not pay enough attention to screening and treatment of depression," said Babak Roshanaei-Moghaddam, M.D., of the psychiatry and behavioral sciences department at the University of Washington in Seattle. "This study further underscores the importance of screening for depression in such programs that can potentially lead to both physical and psychological well-being."


General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Inc.


Simon GE, et al. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psych 32(6), 2010.

1 In 5 Iraq And Afghanistan Veterans Suffer From PTSD Or Major Depression

Nearly 20 percent of military service members who have returned from Iraq and Afghanistan -- 300,000 in all -- report symptoms of post traumatic stress disorder or major depression, yet only slight more than half have sought treatment, according to a new RAND Corporation study.



In addition, researchers found about 19 percent of returning service members report that they experienced a possible traumatic brain injury while deployed, with 7 percent reporting both a probable brain injury and current PTSD or major depression.



Many service members said they do not seek treatment for psychological illnesses because they fear it will harm their careers. But even among those who do seek help for PTSD or major depression, only about half receive treatment that researchers consider "minimally adequate" for their illnesses.



In the first analysis of its kind, researchers estimate that PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment -- an amount that includes both direct medical care and costs for lost productivity and suicide. Investing in more high-quality treatment could save close to $2 billion within two years by substantially reducing those indirect costs, the 500-page study concludes.



"There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, the project's co-leader and a researcher at RAND, a nonprofit research organization. "Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need."



The findings are from the first large-scale, nongovernmental assessment of the psychological and cognitive needs of military service members who have served in Iraq and Afghanistan over the past six years. The RAND study is the first to comprehensively assess the current needs of returned service members from all branches of the military.



Researchers concluded that a major national effort is needed to expand and improve the capacity of the mental health system to provide effective care to service members and veterans. The effort must include the military, veteran and civilian health care systems, and should focus on training more providers to use high-quality, evidence-based treatment methods and encouraging service members and veterans to seek needed care.
















Since October 2001, about 1.6 million U.S. troops have deployed to the wars in Iraq and Afghanistan, with many exposed to prolonged periods of combat-related stress or traumatic events. Early evidence suggests that the psychological toll of the deployments may be disproportionately high compared with physical injuries.



Tanielian and project co-leader Lisa Jaycox headed a group of 25 RAND researchers who conducted a three-pronged assessment of the needs of returning service members: a national survey of those who had served in Iraq and Afghanistan to assess their psychological and cognitive injuries; economic modeling to estimate the cost not only of providing needed treatment, as well as the costs associated with lost productivity and suicide; and an assessment of treatment services that are available to service members, as well as barriers to treatment.



Researchers surveyed 1,965 service members from 24 communities across the country to assess their exposure to traumatic events and possible brain injury while deployed, evaluate current symptoms of psychological illness, and gauge whether they have received care for combat-related problems.



Service members reported exposure to a wide range of traumatic events while deployed, with half saying they had a friend who was seriously wounded or killed, 45 percent reporting they saw dead or seriously injured non-combatants, and over 10 percent saying they were injured themselves and required hospitalization.



Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions, but the single best predictor of PTSD and depression was exposure to combat trauma while deployed.



Researchers found many treatment gaps exist for those with PTSD and depression. Just 53 percent of service members with PTSD or depression sought help from a provider over the past year, and of those who sought care, roughly half got minimally adequate treatment.



"If PTSD and depression go untreated or are under treated, there is a cascading set of consequences," Jaycox said. "Drug use, suicide, marital problems and unemployment are some of the consequences. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general."



Service members report many reasons for not seeking treatment. Many are worried about the side effects of medication or believe that family and friends can provide more help than a mental health professional. Even more reported that they worried seeking care might damage their career or cause their peers to lose confidence in their abilities.



The RAND report recommends the military create a system that would allow service members to receive mental health services confidentially in order to ease concerns about negative career repercussions.



"We need to remove the institutional cultural barriers that discourage soldiers from seeking care," Tanielian said. "Just because someone is getting mental health care does not mean that they are not able to do their job. Seeking mental health treatment should be seen as a sign of strength and interest in getting better, not a weakness. People need to get help as early as possible, not only once their symptoms become severe and disabling."



Researchers also found an urgent need to train more mental health providers throughout the U.S. health care system on delivering evidence-based treatments to service members and veterans. While many opportunities for treatment exist for active-duty personnel, there is no system in place to monitor the quality of those services to ensure they are getting the latest science-based forms of treatment.



The Department of Defense's newly created Defense Center for Excellence for Psychological Health and Traumatic Brain Injury may provide a historic opportunity to change the culture of psychological health within the military and to promote and monitor the use of high-quality care to service members. The RAND report provides information that the center could use to pursue these objectives through the use of innovative care models and performance measurement techniques.



Researchers suggest special training programs are needed to instruct mental health providers in the military, veterans and civilian health systems about the type of evidence-based treatments needed by service members. Only providers with such training should be eligible to treat service members and payment programs should be retooled to reward providers who use science-based treatments.



"It's going to take system-level changes -- not a series of small band-aids -- to improve treatments for these illnesses," Tanielian said.



The RAND study estimates the societal costs of PTSD and major depression for two years after deployment range from about $6,000 to more than $25,000 per case. Depending whether the economic cost of suicide is included, the RAND study estimates the total society costs of the conditions for two years range from $4 billion to $6.2 billion.



The RAND study also estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment -- the term used to describe a range of injuries from mild concussions to severe penetrating head wounds. Just 43 percent reported ever being evaluated by a physician for that injury.



While most civilian traumatic brain injuries are mild and do not lead to long-term impairments, the extent of impairments that service members experience and whether they require treatment is largely unknown, researchers said. In the absence of a medical examination and prognosis, however, service members may believe that their post-deployment difficulties are due to head injuries even when they are not.



One-year estimates of the societal cost associated with treated cases of mild traumatic brain injury range up to $32,000 per case, while estimates for treated moderate to severe cases range from $268,000 to more than $408,000. Estimates of the total one-year societal cost of the roughly 2,700 cases of traumatic brain injury identified to date range from $591 million to $910 million.







The report is titled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." The full report and several summaries are available at veterans.rand/.



The project, jointly conducted by RAND Health and the RAND National Security Research Division, was sponsored by a grant from the California Community Foundation.



RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.



The RAND National Security Research Division conducts research and analysis for the Office of the Secretary of Defense, the Joint Staff, the Unified Commands, the defense agencies, the Department of the Navy, the U.S. intelligence community, allied foreign governments and foundations.



The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.